Abstract :
Tracheostomy is a common surgical procedure, and is increasingly performed in the intensive care unit
(ICU) as opposed to the operating room. Procedural knowledge is essential and is therefore outlined in this
review. We also review several high-quality studies comparing percutaneous dilational tracheostomy and
open surgical tracheostomy. The percutaneous method has a comparable, if not superior, safety profile and
lower cost compared with the open surgical approach; therefore the percutaneous method is increasingly
chosen. Standard and specialized varieties of tracheostomy tubes are available and the appropriate type is
determined by patient anatomy and the indication for the tracheostomy. Fibre optic endoscopic evaluation
of swallowing should be considered in assessment of bulbar function and tracheostomy weaning. A patient
with a tracheostomy who develops respiratory
Distress during the ward weaning process should be investigated for upper airway pathology. Studies
comparing early versus late tracheostomy suggest morbidity benefits that include less nosocomial
pneumonia, shorter mechanical ventilation and shorter stay in the ICU. However, we discuss the questions
that remain regarding the optimal timing of tracheostomy. We outline the potential acute and chronic
complications of tracheostomy and their management, and we review the different tracheostomy tubes,
their indications and when to remove them.
Keyword :
Percutaneous, Dilatation, Fascia, Bronchoscopy, Decannulation.